VA Reorganization 2026: 30,000 Gone, 18 Regions Become 5

Last Updated: September 23, 2026 Reading Time: 9 min

The VA's top healthcare official walked out the door on July 6, right in the middle of the largest VA reorganization in 30 years. If you are one of the roughly 300,000 people working in VA healthcare, the VA reorganization now runs through a leadership vacuum, a shrinking workforce, and an electronic records rollout that most staff still distrust. Here is what actually changes for your job, and what to do about it.

The Departure That Leaves VHA Without a Confirmed Leader

John Bartrum was the first Senate-confirmed Undersecretary for Health of either Trump term. The position sat vacant for the entire first term. He was confirmed 53 to 43 on December 18, 2025, submitted his resignation June 30, 2026, and left July 6, citing family and health reasons.

His replacement, on an acting basis, is John Figueroa, named Acting Under Secretary for Health in July 2026 (designation effective July 9).

There is no announced timeline for a permanent nominee. Bartrum's own confirmation took nearly a year of the second term. VA employees should plan as if "acting leadership" is the durable state through the end of 2026, and probably longer.

Why it matters: Bartrum was the executive champion of the reorganization. The decisions about which VISN positions get merged, which facilities become hubs, and how workforce transitions get handled now rest with an acting official who lacks Senate confirmation and the political capital that comes with it.

What VHA RISE Actually Changes

RISE (Restructure for Impact and Sustainability Effort) is the largest VHA overhaul since 1995. The core structural move: the 18 Veterans Integrated Service Networks that have organized VA healthcare since the 1990s collapse into 5 mega-networks, supported by 18 Health Service Areas (VA's RISE page as of September 16, 2026).

The new regions are large. On VA's official map, updated September 17, 2026, VISN 1 covers 12 states plus the District of Columbia, and VISN 2 covers 6 states plus Puerto Rico and the U.S. Virgin Islands. Our VISN lookup lists all five networks and their 18 Health Service Areas.

Updated October 4, 2026 from VA's VISN page and VA OIG report 26-00084-274.

The leadership consolidation phase is happening right now, which is exactly why Bartrum's timing stings. The people deciding which of 18 director-level teams survive are doing it without a confirmed boss.

The geographic overlay matters too. VA has named Tennessee, Arizona, and the broader Southeast as veteran population growth hubs where staffing will shift. Regions with declining veteran populations, which analysts read as the Northeast and Great Lakes, are expected to draw down.

If you hold an administrative role in a VISN headquarters in a declining region, you are in the highest-risk cell of that table. Start planning now, not when the announcement lands.

"Not a RIF" Is Doing a Lot of Work

Secretary Collins has said repeatedly that RISE is not a reduction in force. That is technically accurate and worth unpacking, because the distinction has real consequences for your rights.

The 30,000 employees who left VA in FY2025 departed through attrition, retirements, and resignations. About 88% came from healthcare positions: roughly 3,000 registered nurses, 1,000 physicians, 700 social workers, and 1,500 schedulers. On top of that, VA is permanently closing 24,000 to 25,000 vacant positions left over from pandemic-era hiring.

Here is why the label matters. In a formal RIF, employees get competitive retention standing, assignment rights (the September 2, 2026 rule's replacement for bump and retreat), and 60-day notice. In an attrition-driven drawdown, none of those protections trigger. You simply watch your unit get smaller as departures go unfilled.

AFGE's counterpoint is about process: when VA last restructured at this scale in 1995, it produced a 134-page public plan with staffing and budget detail. RISE has no equivalent public document. The union's contract covering 300,000 VA employees was terminated, reinstated by a federal judge in the spring, and remains in litigation. If you are a bargaining unit employee, your contract status is legally contested ground right now.

The VERA/VSIP Watch: What Would Have to Happen

VA used VERA during its FY2025 reduction (the July 7, 2025 announcement named it), but no new VERA or VSIP window tied to the 2026 reorganization has been announced as of September 23, 2026. The conditions point in one direction:

1. VA says no positions are eliminated; placement is the open question. VA's RISE FAQ (updated September 16, 2026) states that "no offices or positions will be eliminated through this restructure" and that placement into the new framework is ongoing. Our read: 18 headquarters becoming 5 means the same administrative roles cannot all sit in the same places, so where you are placed is the risk, not whether a job exists on paper.
2. Collins has promised no layoffs. VERA and VSIP are exactly the tools agencies use to make workforce reductions voluntary.
3. VA must ask OPM for the authority. It is not automatic, and the request itself would be the signal that involuntary measures could follow for those who decline.

If VERA authority comes, it lowers the retirement threshold to age 50 with 20 years of service, or any age with 25 years. VSIP adds a cash incentive of up to $25,000 under current law.

The smart move is to know your numbers before any window opens. VERA windows are typically short, and the worst time to start figuring out your high-3 average salary is after the announcement.

What the OIG Shortage Report Means for VA Employees

On September 11, 2026, the VA Office of Inspector General published its FY2026 staffing determination (Report 26-01046-271). Facility officials reported 4,712 severe occupational staffing shortages across 389 occupations, and every one of the 139 VHA facilities reported at least one. The spread runs from 4 shortages at the Gulf Coast system to 148 at Birmingham.

Read the number the way the OIG does, not the way the headlines do. A "severe shortage" means an occupation is hard to fill under the OPM definition, and the report says a facility may flag one whether it has zero vacancies or 100 vacancies (page i of the report puts it exactly that way). The OIG does not validate the responses; they came from one official per facility on a questionnaire due April 1, 2026. That is how the count can rise while VA's press office points to vacancy rates of 15% for physicians and 9% for nurses, a rebuttal the department has made to prior editions as well.

The growth has slowed, which the wire coverage did not mention. Shortages jumped 50% into FY2025 (2,959 to 4,434) and then 6.3% into FY2026 (4,434 to 4,712). The problem is plateauing at a high level, not accelerating.

Source: VA OIG Report 26-01046-271, tables 1 and 2 (pp. 6-7). Medical Officer shortages were reported at 97% of facilities (135 of 139) and Nurse at 86% (119 of 139). Hiring-authority column added by FedTools.

Why the list matters to you is stated in the report itself: the OIG names these occupations "so that the VA Secretary may consider special hiring authorities for those occupations." Under 38 U.S.C. § 7412(b), a departmentwide determination lets the Secretary directly appoint into a listed occupation in the following fiscal year. It is discretionary, and a listing at your facility does not hand you anything by itself. What it does give your HR office is evidence, and evidence is what the pay levers require:

• Retention incentive (5 U.S.C. § 5754): up to 25% of basic pay for an individual, 10% for a group, and up to 50% with OPM approval for a critical agency need. Management has to determine in writing that you would likely leave, and you generally sign a service agreement; the written agreement is not required when the incentive is paid in biweekly installments at the full percentage rate (5 CFR 575.310(f)).
• Critical Skill Incentive (VA Notice 23-03, under the PACT Act): up to 25% of annual basic pay for a high-demand or shortage skill, with a service agreement of 28 to 364 days. The authority ends September 30, 2027, so the FY2027 window is the last one on the current law.
• Recruitment and relocation incentives (5 U.S.C. § 5753): for the backfill side, which is where the attrition numbers above bite.

One more original finding. Section 7412(a) directs the Secretary to publish the annual determination in the Federal Register by September 30. A full-text Federal Register search finds no "Annual Determination of Staffing Shortages" notice since November 21, 2016, which means nine facility-level determinations have gone by with no located publication.

For the employee in one of these occupations, the practical translation is the same one the attrition section gives: expect overtime and cross-coverage, put workload impacts in writing, and know your VERA numbers before any window opens. VA has used VERA as a reduction tool before.

Check Your Early-Out Eligibility Now

Use the free VERA Eligibility Checker to see whether you would qualify under early-out rules today. Then run the FERS Retirement Calculator to compare what your pension looks like leaving now versus riding out RISE to mid-2027. If you are close to a milestone, the High-3 Calculator shows how much each additional year adds to your average salary, and the Severance Pay Calculator covers the scenario where you separate without retirement eligibility.

The EHR Rollout Adds a Second Layer of Change

While the org chart gets redrawn, the Oracle Cerner electronic health record keeps rolling out. The program resumed in April 2026 after a 3-year safety pause. Michigan sites went live April 11, Ohio and Kentucky followed June 6, Indiana's three sites went live August 22, and Anchorage and Cleveland are scheduled for October 24 (VA's EHR deployment schedule). Full deployment across 170 sites is not expected until about 2031.

Staff sentiment remains rough. A GAO review found only 13% of users believe the system makes VA as efficient as possible, and 58% believe it has increased patient safety risks. The reliability picture is better: the system logged more than 200 consecutive days without an outage in FY2025.

The risk in the leadership shuffle is political: an acting official has less capital to defend the program if Congress pushes for another pause after any safety incident.

If your site is on the 2026 schedule, expect an intensive training period and a temporary productivity dip. Document workload impacts in writing. That record protects you at performance review time and gives your facility ammunition for staffing requests.

What VA Employees Should Do This Quarter

If you are VISN administrative staff: Update your resume and your eOPF now. Run the VERA Eligibility Checker and know your service computation date cold. Watch HR announcements through fall 2026. If a VERA/VSIP window opens, you will likely have weeks, not months, to decide.

If you are clinical staff: Your position is exempt on paper, but backfills are slow everywhere. Document patient-care impacts of vacancies in writing. That paper trail matters for workload grievances and for your facility's case to central office.

If you are facility support staff in a declining region: Watch where your region lands in the late-2026 realignment phase. A reassignment offer to a growth region is a realistic scenario. Think through your answer before you are asked.

Everyone: The fall 2026 VERA/VSIP agency tracker tracks which agencies have live early-out authority. VA is not on it yet. If that changes, it changes fast.

Frequently Asked Questions

Why did John Bartrum resign from the VA?

He submitted his resignation June 30, 2026, effective July 6, citing family and health reasons, and said he would support the administration from the private sector. He gave no policy disagreement as a reason. He had been confirmed less than 7 months earlier.

Is the VA doing a RIF?

No formal RIF has been announced. The 30,000 FY2025 departures came through attrition, retirements, and resignations, and Secretary Collins insists RISE is not a reduction in force. The distinction matters: attrition-based downsizing does not trigger the retention standing, the assignment rights that replaced bump and retreat on September 2, 2026, or the 60-day notices that a formal RIF would.

Will VA offer early retirement or buyouts under RISE?

Not for the 2026 reorganization. VA used VERA in its FY2025 reduction, but as of September 23, 2026 no new VERA or VSIP window tied to the reorganization has been announced. The VISN consolidation makes one plausible for administrative staff, and VA would need OPM approval first. Watch official HR channels through the fall, and check your eligibility ahead of time.

Who is running VA healthcare now?

John Figueroa was named Acting Under Secretary for Health in July 2026 (VA's designation is effective July 9). No confirmation timeline for a permanent replacement has been announced.

I'm a VA nurse. Does any of this affect me?

Formally, clinical positions are exempt from RISE and from the hiring restrictions. Practically, VHA lost 3,000 nurses to attrition in FY2025, the OIG's FY2026 report lists Nurse shortages at 86% of facilities (119 of 139) and Practical Nurse at 82 facilities, and facility leaders report slow backfill approvals under the staffing caps. Expect leaner staffing to persist, put workload impacts in writing, and ask HR about retention incentives under 5 U.S.C. § 5754 now that your occupation is on the list.

Related Resources

• VERA Eligibility Checker: Check early retirement eligibility under standard and VERA rules
• FERS Retirement Calculator: Model your pension under different retirement dates
• VERA/VSIP Fall 2026 Agency Tracker: Which agencies have live early-out authority
• VA Whistleblower Rights Guide: Your protections during VA investigations

Sources: VA OIG Report 26-01046-271, FY2026 staffing shortages · VA OIG FY2025 report 25-01135-196 · 38 U.S.C. 7412 · 5 U.S.C. 5754 · 5 U.S.C. 5753 · VA Notice 23-03, Critical Skill Incentive · Federal Register search, "Annual Determination of Staffing Shortages" · Federal News Network, VA.gov press release, Marine Corps Times, GovExec